Many of our columns have highlighted the radiology suite as a site where many patient safety issues occur (see our Patient Safety Tips of the Week for October 16, 2007 “More on Radiology as a High Risk Area” and October 7, 2008 “Lessons from Falls....from Rehab Medicine”). In the latter we noted that radiology is an area where falls often happen. Patients are often on a gurney or a table or in a wheelchair and may fall when they attempt to get up to use the bathroom. They may be tethered to IV poles or other equipment that become obstacles to trip over. And they may have received benzodiazepines or other sedating medications for the radiology procedure, further increasing their fall risk. So it is critical that the fall risk of a patient is accurately conveyed to all staff when a patient is sent to radiology. One way to facilitate such handoffs would be to include information on fall risk in a structured communication tool for transports like the “ticket to ride” we described in our April 8, 2008 column. The use of color-coded wristbands continues to gain momentum and may be used to identify patients at greater risk for falls.”, September 16, 2008 “
But most of our discussion has focused on inpatients in the radiology suite. A new paper presented by Abujudeh and colleagues at the Massachusetts General Hospital at the 2009 RSNA annual meeting focused on falls in outpatient radiology areas (see Yee 2009). They analyzed 82 falls in radiology over a 2 ½ year period and found that 80% involved outpatients. About a third of the falls resulted in injury. They noted that risk factors for falls were present in 85% of the patients who fell and 20% had had a previous fall within the past 3 months. Medications, in particular were common predisposing factors.
While the number of falls is small compared to the large volume of outpatient radiological procedures, this still represents a significant patient safety risk and liability risk. It would be interesting to see if incorporation of at least a brief risk assessment at the time a procedure is scheduled or on patient registration would have any impact on falls. In those more integrated systems having good IT capabilities it would make sense to develop risk flags that follow the patient from inpatient to outpatient.
Yee KM. Postcards from the edge:
Tracking falls in outpatient radiology.
AuntMinnie.com December 21, 2009